Abstract
Introduction
Compression of sciatic nerve may often cause symptoms of lumbar radiculopathy. In 90% of patients with sciatica, spinal causes may be found. On the other hand, extraspinal compression of the sciatic nerve is very rare, found only in 10%. Most frequently, the lesion is in the pelvis due to tumors and bony compression. Clinical features are very similar to the usual causes of sciatica. Precise diagnosis is difficult to establish with standard diagnostic procedures due to absence of specific tests. We present cases of extraspinal sciatic nerve compression.
Materials and Methods
At our department, patients with concomitant intra- and extraspinal sciatic nerve compression were treated. All had typical sciatica that was unresponsive to conservative treatment in the beginning, as well as to standard surgical spinal decompression.
Results
Extraspinal origin was found as a cause for the pain: in one case, the tumor in presacral region behind the bladder with destruction of sacrum and compression of sacral plexus; in the second, femoral vein thrombosis, which resulted in massive pulmonary embolism; in the third, abscess of the Douglas pouch, involving the sacral plexus; in the fourth, abscess of psoas muscle and in the fifth, paravertebral muscle abscess.
Conclusion
Clinically, extraspinal compressive pain may hardly be distinguished from intraspinal radicular pain. In contemporary double compressions particularly, the diagnosis is aggravated. The candidates are patients with no improvement after appropriate intraspinal surgery as a result of initial sciatic pain. Early diagnosis of extraspinal compression leads to effective treatment and additional extended diagnostic workup is therefore important.
Yes
None declared
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